Pregnant HIV-Positive Women In East Africa Sometimes Quit Treatment

February 5, 2018

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Once someone is diagnosed with HIV, it is important for them to get on HIV treatment as soon as possible. One especially important group is pregnant women. Preventing mother-to-child transmission of HIV is an imperative step to halting the HIV epidemic, so the World Health Organization in 2013 put forth the recommendation that all HIV-infected pregnant women begin antiretroviral treatment immediately, and continue for their entire life. Due to different circumstances, pregnant women living with HIV might not stay in their HIV care programs and might stop their treatment. This would be a problem, because that could allow her to transmit HIV to her baby during the pregnancy. However, the data on the amount of HIV-positive pregnant women who have dropped out of their HIV treatment programs is relatively unknown.

To attempt to look at the differences in drop-out rates from treatment between men, pregnant women, and non-pregnant women, researchers created the International Epidemiologic Databases to Evaluate AIDS East Africa consortium, which consolidated information from six HIV treatment programs in Kenya, Uganda, and Tanzania funded by the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR). This particular paper looked at data from patients who were 13 years of age or older who began their antiretroviral treatment between January 2004 and December 2014.

From these six HIV treatment programs, 156,474 HIV-positive adults began their antiretroviral treatment between 2004 and 2014, and 67% of them were women. Among these women, 19,130 were pregnant when they began their HIV treatment. Among the HIV-positive adults in this paper, the researchers found that the women who were pregnant when they started treatment were younger than the women who were not pregnant when they started treatment. The pregnant women in the study had less advanced HIV compared to non-pregnant women, and both groups of women had less advanced HIV than the men.

Among the people starting antiretroviral treatment from these six HIV treatment programs in Kenya, Uganda, and Tanzania, the proportion of pregnant women rose from 5.3% to 12.2% between 2004 and 2014. Overall, there was no difference in the dropout rates over two years after starting HIV treatment between pregnant women and non-pregnant women. However, among women who were healthy and started HIV treatment, the pregnant women had significantly higher dropout rates than the non-pregnant women over the two years after starting treatment.

This is unfortunate, as an HIV-positive pregnant woman who stops taking her medication is at risk for poorer health for herself as well as having a higher risk of transmitting HIV to her baby. Therefore, it is incredibly important to try and make sure these HIV-positive pregnant women, especially the ones who are relatively healthy, start taking their HIV treatment and stay on their treatment. Additional work needs to be done to try and figure out why these healthy HIV-positive women are leaving treatment, so that they can be targeted to stay on treatment for both the health of the woman and her baby.